Resection Of Colon Cancer Research Articles

Long-term outcomes following the resection of screen-detected right-sided colon cancer.

The relative outcomes following the resection of screen-detected right-sided colon cancer compared to symptomatic cases are unknown. In this study, short and long-term outcomes after right-sided colectomy in screen-detected colon cancer are compared with symptomatic cases, both emergency and elective. A prospective observational cohort study of patients, including both screen-detected and symptomatic patients (elective and emergency resections), undergoing right-sided colectomy for colon cancer (2010-2020) in a tertiary care unit was conducted. Each patient was followed up for long-term recurrence and survival. A total of 909 patients (median age, 70; IQR, 58-82; male, 52%) were included (151 patients (16.6%) screen-detected; 598 (65.8%) elective and 160 (17.6%) emergency). Screen-detected patients were more likely to haveT1 or T2 lesions compared to elective and emergency groups (T1: 14.6% vs. 3.8% vs. 0.6% p<0.001; T2: 16.6% vs. 8.9% vs. 3.1% p<0.001), but were less likely to have T3 or T4 lesions (p<0.001), respectively. Rates of N0 were higher in the screen-detected group (68.9% vs. 63.5% vs. 41.9%, respectively; p<0.001). 98% of the screen-detected group achieved R0 resection compared to 93.3% of elective and 79.4% of emergency patients (p<0.001). At 5-years following resection, overall survival for the screen-detected, elective, and emergency groups were 85.4%, 75.4%, and 53.1%, respectively (p<0.001). Recurrence at 5-year post-resection were 8%, 15.1%, and 22.5% for the screen-detected, elective, and emergency groups, respectively (p<0.001). When considering right-sided colon cancer alone, screen-detected cancers have a lower long-term recurrence rate, lower rates of postoperative complication, and superior survival compared to symptomatic groups following resection.

Oncologic outcomes and trends in each colon cancer location and stages over the last two decades: insights from the SEER registry.

The main purpose of the study is to comprehensively evaluate population-level survival disparities stage-by-stage, according to specific anatomical colon segments, and based on prognosis as defined by lymph nodes among patients who have undergone curative resection for non-metastatic colon cancer. The study was conducted from the Surveillance Epidemiology and End Result (SEER) program from the USA. Patients who underwent surgery for colon adenocarcinoma between 2000 and 2019 were identified. Demographics and clinical and pathologic factors were compared amongst each other according to different colon segments, stages, and time periods. A total of 482,672 patients were identified and 195,105 of them met the inclusion criteria. Patients with proximal cancers were significantly older, more likely to be female, had a higher number of lymph nodes, and node positivity (p < 0.001). During the study period, an almost 10% improvement in overall survival rate was observed at 3 and 5years for each colon site and stage (p < 0.05). The study's findings revealed a notable improvement in overall and cancer-specific survival rates across all colon segments and stages in patients who underwent curative treatment for non-metastatic primary colon cancer from a nationwide database.

Phase II trial evaluating the long-term efficacy and peripheral sensory neuropathy of capecitabine plus oxaliplatin (XELOX) as adjuvant therapy in Japanese patients with operated stage III colon cancer

Adjuvant oxaliplatin plus capecitabine (XELOX) therapy is recommended for patients with curatively resected colon cancer. However, prospective data on its practical application in Japanese patients are limited. Therefore, we aimed to conduct a long-term clinical evaluation of the efficacy and safety of adjuvant XELOX in patients with curatively resected stage III colon cancer (MCSCO-1024). This prospective, multi-center, open-label, single-arm, phase II study enrolled patients with curatively resected stage III colon cancer. The treatment protocol consisted of a 120-minute intravenous infusion of oxaliplatin (130 mg/m2) on day 1 and two divided doses oral capecitabine (2000 mg/m2/day) for 14 days in a 3-week cycle, totaling eight cycles (24 weeks). The primary endpoint was 3-year disease-free survival (DFS), and the secondary endpoints were 5-year overall survival and long-term prognosis of peripheral sensory neuropathy. A total of 196 patients were enrolled between November 2011 and August 2014 (34 months). The 3-year DFS rate was 73%, and the 5-year overall survival rate was 87%. The overall incidence of peripheral sensory neuropathy was 17%, with a 1% rate of grade 3 neuropathy after 5 years. Adjuvant XELOX demonstrated utility and safety in the clinical management of Japanese patients with stage III colon cancer.

Risk of metachronous peritoneal metastases after surgery for obstructive colon cancer: Multivariate analysis from a series of 1,085 patients

BackgroundData in the literature suggest that obstruction is an independent predictor of poor prognosis in colon cancer. Of all possible sites of recurrence, peritoneal metastases are associated with worse survival. Our aim was to report the incidence of metachronous peritoneal metastases from a cohort of patients undergoing resection of obstructive colon cancer with curative intent and to identify predictive factors for metachronous peritoneal metastases. MethodsFrom 2000 to 2015, a total of 2,325 patients were treated for obstructive colon cancer in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management, synchronous metastatic disease, and with postoperative mortality were excluded. A multivariate analysis was performed to determine independent predictive factors of metachronous peritoneal metastases. ResultsThe cohort included 1,085 patients. The median follow-up was 21.5 months. Metachronous peritoneal metastases occurred in 12% of patients and were diagnosed after a median interval of 13.5 months. The cumulative 3-year metachronous peritoneal metastasis rate was 10.9%. Three-year overall survival was 85% for patients who did not develop recurrence, 71% for those who develop recurrence without peritoneal metastases, and 56% for those with metachronous peritoneal metastases (P < .0001). In multivariate analysis, 3 variables were identified as independent risk factors for metachronous peritoneal metastases: pT4 stage (odds ratio: 1.98; 95% confidence interval: 1.17–3.36; P = .011), pN2 stage (odds ratio: 2.57; 95% confidence interval: 1.89–4.45; P = .0007), and fewer than 12 lymph nodes examined (odds ratio: 2.01; 95% confidence interval: 1.08–3.74; P = .028). ConclusionThis study showed a significant risk of metachronous peritoneal metastases after curative-intent resection of obstructive colon cancer. The awareness of factors predisposing to metachronous peritoneal metastases could improve the treatment strategy of these patients.

Long-term follow-up of the conventional versus no-touch isolation technique for resection of primary colon cancer (JCOG1006): randomized clinical trial.

The Japan Clinical Oncology Group (JCOG) 1006 was a phase III trial of patients with clinical T3/T4 colon cancer comparing the no-touch isolation technique ('No Touch') with the conventional technique ('Conventional'). The planned primary analysis at 3 years failed to confirm the superiority of the No Touch over the 'Conventional'. The present study aimed to compare the 'No Touch' and 'Conventional' using long-term (6-year) follow-up data. Patients aged 20-80 years who had a clinical classification of T3-4, N0-2, and M0 with histologically proven colon cancer were randomly assigned (1 : 1) to undergo open surgery using 'Conventional' or 'No Touch' techniques. The primary endpoint was disease-free survival. In total, 853 patients from 30 institutions were assigned to the 'Conventional' (427) or 'No Touch' (426) groups between June 2011 and November 2015. The 6-year disease-free survival was 70.3% and 69.4% for 'Conventional' and 'No Touch' arms respectively (HR 1.030; 95% c.i. 0.813 to 1.304; one-sided P = 0.60). The 6-year overall survival was 89.4% and 86.6% respectively (HR 1.276; 95% c.i. 0.902 to 1.807). The 6-year relapse-free survival was 78.9% and 75.0% respectively (HR 1.209; 95% c.i. 0.920 to 1.589). The 6-year liver relapse-free survival was 85.1% and 80.2% respectively (HR 1.311; 95% c.i. 0.961 to 1.787). Long-term follow-up data did not support the superiority of 'No Touch' over 'Conventional' technique in patients with stages II and III colon cancer. These study findings indicate that the conventional technique is still standard surgery for managing colon cancers. UMIN000004957.

Colon Cancer With Bladder Invasion: A Single Center Experience.

The aim of our study was to investigate the outcome of colon cancer with bladder invasion after surgical intervention. Between 2011 and 2022, a total of 41 patients diagnosed with colon cancer and bladder invasion underwent surgical procedures at Taichung Veterans General Hospital. The impact of various risk factors on overall survival (OS) was assessed using Kaplan-Meier analyses and Cox proportional hazards models. Among the enrolled patients, 21 underwent radical cystectomy, while 20 underwent partial cystectomy. Twelve had tumors located in the rectum, 19 in the sigmoid colon, and 10 in both the rectum and sigmoid colon. The median OS was 71.8 months in stage 2, 50.8 months in stage 3, and 11.2 months in stage 4 (p=0.061). Median OS was 71.8 months in patients with negative surgical margins and 10.5 months in those with positive surgical margins (p=0.003). In multivariate regression analysis, positive surgical margins [hazard ratio (HR)=3.64, 95% confidence interval (CI)=1.28-10.34, p=0.015] and emergency operations (HR=4.57, 95%CI=1.34-15.55, p=0.015) significantly impacted OS. Complete resection of colon cancer with bladder invasion can yield excellent oncologic outcomes. The decision between partial and radical cystectomy should balance surgical margin clearance and the preservation of quality of life. Both surgical margin involvement and emergency operations are independent risk factors for OS.

NRXN1 as a Prognostic Biomarker: Linking Copy Number Variation to EMT and Survival in Colon Cancer.

The role of biomarkers in cancer treatment varies significantly depending on the cancer stage. Thus, in clinical practice, tailoring biomarkers to meet the specific needs and challenges of each cancer stage can increase the precision of treatment. Because they reflect underlying genetic alterations that influence cancer progression, copy number variation (CNV) biomarkers can play crucial prognostic roles. In our previous study, we identified potential survival-related genes for colorectal cancer (CRC) by analyzing CNV and gene expression data using a machine-learning approach. To further investigate the biological function of NRXN1, we assessed the use of RNA sequencing, phosphokinase assays, real-time quantitative PCR, and Western blot analysis. We found that NRXN1 copy number deletion was significantly associated with poor overall survival (OS) and recurrence-free survival (RFS), even in patients who received adjuvant chemotherapy. Compared with its expression in normal tissues, NRXN1 expression was lower in tumors, suggesting its potential role as a tumor suppressor. NRXN1 knockdown enhanced CRC cell viability and invasion, and transcriptome analysis indicated that the increased invasion was caused by GSK3β-mediated epithelial-mesenchymal transition. These findings highlight NRXN1 copy number deletion as a novel biomarker for predicting recurrence and survival in patients with resected colon cancer.

Short- and long-term outcomes of laparoscopic right hemicolectomy with D3 resection for right colon cancer in elderly patients.

Laparoscopic right hemicolectomy (RHC) with D3 resection, similar to complete mesocolic excision, is an oncologically satisfying procedure; however, it remains controversial in elderly patients. There are no reports of the procedure for tumors fed by middle colic vessels because it is a difficult procedure. We evaluated the feasibility and oncological outcomes of the procedure in elderly patients. We retrospectively evaluated 336 consecutive patients undergoing laparoscopic right hemicolectomy with D3 resection for Stage I-III ascending and transverse colon cancer between 2010 and 2021. Patients were divided into the EP (age ≥ 75 years) and nEP (age < 75 years) groups, and short- and long-term outcomes were analyzed using propensity score matching. The median follow-up period was 60.7 months. After matching, we enrolled 129 patients. The surgery time, estimated blood loss, postoperative complication rate, number of harvested lymph nodes, and recurrence rate did not differ significantly between the groups; however, the adjuvant chemotherapy rate was significantly lower in the EP group. The EP group had significantly shorter overall survival (OS) (p < 0.01) than the nEP group; however, the cancer-specific (p = 0.15) and recurrence-free (p = 0.36) survivals did not differ significantly from those in the nEP group. In multivariate analyses, age ≥ 75 years, ASA ≥ 3, and pT4 were independent prognostic factors for OS (p = 0.02, < 0.01, < 0.01, respectively); however, only pT4 was an independent prognostic factor for CSS and RFS (p < 0.01 for both). This procedure offers safe, feasible, and satisfactory oncological outcomes for elderly patients.

Deep learning-based surgical step recognition for laparoscopic right-sided colectomy.

Understanding the complex anatomy and surgical steps involved in laparoscopic right-sided colectomy (LAP-RC) is essential for standardizing the surgical procedure. Deep-learning (DL)-based computer vision can achieve this. This study aimed to develop a step recognition model for LAP-RC using a dataset of surgical videos with annotated step information and evaluate its recognition performance. This single-center retrospective study utilized a video dataset of laparoscopic ileocecal resection (LAP-ICR) and laparoscopic right-sided hemicolectomy (LAP-RHC) for right-sided colon cancer performed between January 2018 and March 2022. The videos were split into still images, which were divided into training, validation, and test sets using 66%, 17%, and 17% of the data, respectively. Videos were manually classified into eight main steps: 1) medial mobilization, 2) central vascular ligation, 3) dissection of the superior mesenteric vein, 4) retroperitoneal mobilization, 5) lateral mobilization, 6) cranial mobilization, 7) mesocolon resection, and 8) intracorporeal anastomosis. In a simpler version, consecutive surgical steps were combined, resulting in five steps. Precision, recall, F1 scores, and overall accuracy were assessed to evaluate the model's performance in the surgical step classification task. Seventy-eight patients were included; LAP-ICR and LAP-RHC were performed in 35 (44%) and 44 (56%) patients, respectively. The overall accuracy was 72.1% and 82.9% for the eight-step and combined five-step classification tasks, respectively. The automatic surgical step-recognition model for LAP-RCs, developed using a DL algorithm, exhibited a fairly high classification performance. A model that understands the complex steps of LAP-RC will aid the standardization of the surgical procedure.

Clinical Effects of Laparoscopic Radical Colon Cancer Treatment with Complete Mesocolic Resection for Colon Cancer

Objective: This paper aims to evaluate the effect of laparoscopic complete mesocolic resection on the efficacy and survival of patients with colon cancer. Methods: 80 colon cancer patients were included in this study, 40 of whom were treated with traditional radical colon cancer surgery as the control group, and the other 40 were treated with laparoscopic complete mesocolic resection radical colon cancer surgery as the observation group. The study period lasted from April 2022 to April 2023, and the surgical indexes, postoperative recovery, quality of life, and the occurrence of complications of the two groups were monitored throughout the whole process and compared and analyzed. Results: The therapeutic effect of the observation group was better than that of the control group (P &lt; 0.05). The operation time, bleeding volume and postoperative hospitalization time of the observation group were significantly lower than those of the control group, and the number of lymph node dissection was significantly higher than that of the control group, with highly significant differences (all P &lt; 0.001). The postoperative recovery of the observation group (time of first anal defecation, time of first solid food intake, and time of wound healing) was significantly better than that of the control group (all P &lt; 0.001). The quality of life of the observation group was significantly improved with a highly significant correlation (P &lt; 0.001), and the complication rate was significantly lower than that of the control group (P &lt; 0.05). Conclusion: Laparoscopic radical colon cancer surgery with complete mesocolic resection for colon cancer shows better clinical effects and advantages in the treatment of colon cancer, which is worth further promotion and application in clinical practice.

Unexpected peritoneal metastases diagnosed at the time of primary colon cancer resection: controversies regarding options for management.

Peritoneal metastases synchronously occurring in the patient with primary colon cancer causes that patient to be at high risk for subsequent disease progression within the abdomen and pelvis. If peritoneal metastases are preoperatively diagnosed, patients are likely to be treated with neoadjuvant chemotherapy with or without biological therapy prior to cytoreductive surgery (CRS). However, if one only considers patients with peritoneal metastases unexpectedly identified at the time of primary colon cancer resection, the optimal management strategy is neither standardized nor evidence based. These authors present an opinion regarding treatment options in unexpectedly (incidentally) detected peritoneal metastases. The primary colon cancer may be asymptomatic (elective list) or may present as an emergency with obstruction or with perforation. The fitness of the patient, the condition of the colon, availability of a colonic stent, consent of the patient and capabilities of the institution for management of peritoneal metastases by CRS and intraperitoneal chemotherapy cannot be ignored and must all be considered. These patients with known peritoneal metastases should not be allowed to return for further treatment with advanced disease after multiple regimens of systemic chemotherapy. Delay in definitive management will cause peritoneal metastases to be unresectable and not amenable to cure. It is time to debate optimal management strategies for unexpectedly detected peritoneal metastases. The authors find the data compelling that the modifications presented in the management of unexpected peritoneal metastases documented at the time of colon cancer resection changes a palliative approach to treatment to a plan that has curative intent.

Inequalities in quality metrics for colorectal cancer surgery in older adults: A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program registry

BackgroundWith a growing proportion of patients undergoing surgery for colorectal cancer being older adults, it is unknown whether traditional quality metrics are achieved as often compared with younger adults. This work was done with a view to understand tailoring needs of quality metrics for older adults with colorectal cancer. MethodsThis retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program registry to identify adults (≥18 years) between 2016 and 2021 who underwent elective colorectal cancer surgery for nonmetastatic cancer. older adults was defined as adults ≥65 years. The association between older adults and attainment of consensus quality metrics were evaluated using multivariable logistic regression adjusting for patient, cancer, and treatment factors. ResultsOf 46,159 patients undergoing elective colon cancer resection, 18,592 (40.3%) were older adults. Being an older adult was independently associated with a 14% reduction in odds of harvest of ≥12 nodes and 4.3 times increase in odds of 30-day mortality. Of 9,106 patients undergoing elective rectal cancer resection 5,143 (56.5%) were older adults. Being an older adult was independently associated with a 19% reduction in odds of harvest of ≥12 nodes, 2.3 times increase in odds of 30-day mortality and a 44% reduction in odds of receiving neoadjuvant radiation. Findings were robust to sensitivity analyses of alternate methods of handling missing data and alternate analytic approaches. ConclusionGiven unique needs of the older adult population, interpretation of disparities in quality metrics is challenging because of an inability to differentiate between patient factors, tailored care, or bias. Monitoring and reporting of quality metrics for older adults need to be re-evaluated with consideration to stratification, unique benchmarks, and older adult–specific quality metrics.

Impact of dexmedetomidine-assisted anesthesia in elderly patients undergoing radical resection of colon cancer.

Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy. However, due to the physiological characteristics of elderly patients, the safety of perioperative anesthesia needs special attention. As an α2-adrenergic receptor agonist, dexmedetomidine (Dex) has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure, inhibitory effect on inflammation, and sedative and analgesic effects. Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer. To investigate the anesthetic effects of Dex during radical surgery for colon cancer under general anesthesia in elderly patients. A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital, Qingdao, China were recruited and divided into two groups: A and B. In group A, Dex was administered 30 min before surgery, while group B received an equivalent amount of normal saline. The hemodynamic changes, pulmonary compliance, airway pressure, inflammatory factors, confusion assessment method scores, Ramsay Sedation-Agitation Scale scores, and cellular immune function indicators were compared between the two groups. Group A showed less intraoperative hemodynamic fluctuations, better pulmonary compliance, and lower airway resistance compared with group B. Twelve hours after the surgery, the serum levels of TLR-2, TLR-4, IL-6, and TNF-α in group A were significantly lower than those of group B (P < 0.05). After extubation, the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients, indicating a higher level of sedation. The incidence of delirium was significantly lower in group A than in group B (P < 0.05). The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.

FP4.10 - Oncosurgical Outcome Differences of Left and Right Colonic Cancer Resections Still a Colorectal Enigma

Abstract Aims The study aimed to compare surgical outcomes between right (RCC) and left colonic cancer (LCC) resections at a single centre (DGH) with special reference to 3 and 5-year survival rates. Methods 100 colonic resections (2017-2021) were included. Length of stay (LOS), pathology results and 3 and 5-year survival rates were analysed. The Kaplan-Meier estimate was used for patients within 5 years post-operative. Results 68 RCC and 32 LCC noted. RCC: 37 female, 31 male, median age of 73. 66 R0 resections, 2 R1, none R2. TNM: 52 (86.1%) had T3/4, 26 (38.2%) had N1/2. 20 had extramural venous invasion (EMVI), 26 intramural venous invasion (IMVI), 8 mucinous, 11 perineural invasion. Estimated 3-year survival rate 0.8530, 5-year 0.7766. No local recurrences, 4 subsequent distant metastases within 5 years. LCC: 11 female, 21 male, median age of 67. 23 R0, 2 R1, 2 R2 resections. TNM: 28 (87.5%) had T3/4, 15 (46.9%) had N1/2. 18 EMVI, 11 IMVI, 1 mucinous, 9 perineural invasion. Estimated 3-year survival rate 0.7498, 5-year 0.5965. No local recurrences, 9 subsequent distant metastases within 5 years. Both cohorts’ median LOS similar (6 days). Discussion This study shows higher survival rates in RCC, contradicting acclaimed superiority of LCC survival in literature(1-5). The limited LCCs in this study (during Covid pandemic) being pathologically more advanced, possibly accounts for the statistically significant mortality. A prospective audit of tumour biology and oncological outcome is ongoing with intentions to validate our early observation.

SP3.10 - Utilisation and Outcomes of Emergency Laparoscopic Resection for Colon Cancer: A Population-based Study in England

Abstract Aims To evaluate the current use and outcomes of urgent or emergency laparoscopic resection of colon cancer in the National Health Service in England. Methods 11,182 patients from the National Bowel Cancer Audit diagnosed with colon cancer from April 2017 to March 2022 in England, who underwent urgent or emergency resection, were included. Multivariable logistic and linear regression was used to quantify factors associated with use of laparoscopic surgery and compare risk-adjusted postoperative outcomes between laparoscopic and open surgery. Results The use of emergency laparoscopic resection increased from 33.0% in 2017 to 47.5% in 2022, with a temporary stabilisation during the first wave of the COVID-19 pandemic (38.9% 2020/21). In risk-adjusted analyses of 9,579 patients, patients with poorer physical status [ASA 4/5 vs 1, aOR 0.35 (95% confidence interval 0.27-0.44) P &amp;lt; 0.001], more advanced T-stage [T4 vs T1-T2, aOR 0.26 (0.21-0.32) P &amp;lt; 0.001] and M-stage [M1 vs M0, aOR 0.87 (0.76-0.99) P &amp;lt; 0.036] were less likely to undergo laparoscopic surgery. No association was found with age, socioeconomic deprivation, or nodal stage. Patients undergoing laparoscopic resection had a shorter length of stay [adjusted mean difference -2.55 days (-3.23, -1.87), P &amp;lt; 0.001], lower 90-day mortality [aOR 0.75 (0.63-0.89), P = 0.001], and lower 30-day unplanned reoperation [aOR 0.82 (0.70-0.96), P = 0.014] than patients undergoing open resection. Conclusion There has been an increased utilisation of laparoscopic surgery in the emergency setting, and it is associated with reduced hospital stay, postoperative mortality and unplanned reoperation.

MOY 1 - The Emergency General Surgeon: what should their future operative role be, and how can an EGS post be more attractive?

Abstract Aims Determine the desired future operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI), and how to improve the attractiveness of an EGS post. Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked using a Likert scale which operations a dedicated EGS surgeon should perform and how an EGS post could be more attractive. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. Respondents stated the desired future operative role of EGS surgeons included most EGS operations, including for torso trauma. Few believed EGS surgeons should perform emergency colonic resection for cancer (49%) or inflammatory bowel disease (37%), gastric volvulus (34%), bariatric complications (26%), or Boerhaaves (28%). The vast majority agreed that EGS posts could be improved by including elective general and subspecialty operating lists, continuing professional development, minimally-invasive (laparoscopic/robotic) opportunities, rest days post-on-call, family-friendly hours, EGS ambulatory and follow-up clinics, and major trauma responsibility. Conclusions EGS surgeons should operate on the majority of EGS patients. Job plans that include elective operating, professional development, and patient follow-up may improve recruitment and retention.

WP4.19 - The Emergency General Surgeon: what is their current operative role?

Abstract Aims Determine the current operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI). Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked which surgeons usually perform the most common EGS operations in their hospital. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. The general surgeon on-call – or a dedicated EGS surgeon, where such service exists – operates on the majority of EGS pathology through an un-selected take. A surgeon with the relevant sub-specialty interest usually operates on emergency non-traumatic complex upper gastrointestinal or colorectal pathology. These include emergency colonic resections for cancer or inflammatory bowel disease, and operations for gastric volvulus, bariatric complications, and Boerhaaves. Acute cholecystectomy forms a major part of a dedicated EGS surgeon’s practice. Conclusions Dedicated EGS surgeons deliver a wide variety of operations, in addition to the peri-operative management of acute surgical patients. Future curriculum design and NHS workforce planning should reflect this service delivery pattern, should EGS become a recognised specialty interest.

Robotic purse-string suture technique for intracorporeal anastomosis using double-stapling technique in robotic resection of rectal and sigmoid colon cancer: a propensity score-matched analysis

BackgroundRobotic three-dimensional magnified visual effects and field of view stabilization have enabled precise surgical operations. Intracorporeal anastomosis in right-sided colorectal cancer surgery is expected to shorten operation times, avoid paralytic ileus, and shorten wound lengths; however, there are few reports of intracorporeal anvil fixation for intestinal anastomosis in left-sided colorectal cancer surgery. Herein, we introduce a simple, novel procedure for using robotic purse-string suture (RPSS) in intracorporeal anastomosis with the double-stapling technique in rectal and sigmoid cancer surgery and report short-term outcomes.MethodsFrom September 2022 to April 2024, 105 consecutive patients underwent robotic surgery with double-stapling technique anastomosis for rectal or sigmoid colon cancer at our institution. Their data were retrospectively analyzed. Intracorporeal anastomosis with the double-stapling technique using RPSS was performed in 26 patients (the RPSS group), while the double-stapling technique anastomosis with extracorporeal anvil fixation was performed in 79 patients (the EC group). A 1:1 propensity score-matched analysis was performed (matching criteria: sex, age, body mass index (BMI), tumor location and tumor size) using a caliper 0.3.In the RPSS group, after tumor-specific or total mesorectal excision, specimens were extracted from the umbilical wound with simultaneous anvil placement in the body cavity. The oral colonic stump was robotically excised and robotically circumferentially stitched with 3–0 Prolene in all layers. After anvil insertion into the stump, the bowel wall of the colon was completely sewn onto the central rod of the anvil. Reconstructions were anastomosed using the double-stapling technique.ResultsThe matched cohort contained 23 patients in each group. The RPSS group had significantly less bleeding than the EC group (p = 0.038). Super-low anterior resection (SLAR) in the RPSS group had shorter total operative times than those in the EC group (p = 0.045). The RPSS group experienced no perioperative complications greater than Clavien–Dindo grade III or any anastomosis-related complications.ConclusionsThe RPSS technique can be performed safely without any anastomosis-related complications and reduces the total operative times in SLAR and blood loss through total robotic surgery. This may be a useful modality for robotic colorectal surgery.

A randomized controlled clinical trial on multimodal prehabilitation in colorectal cancer patients to improve functional capacity: preliminary results

IntroductionMajor colorectal surgery is associated with 20 to 40% reduction in physiological and functional capacity and higher level of fatigue 6 to 8 weeks after surgery. The primary aim of this study was to analyse the effects of a multimodal prehabilitation program in colorectal cancer patients to improve functional capacity. The secondary outcome was to evaluate postoperative complications and length of postoperative hospital stay as well as to determine the costs of implementation and indirect costs.MethodsA single centre, single-blind, randomized controlled trial was conducted. Patients of age > 18 years undergoing elective colorectal resection for colonic cancer were eligible. Exclusion criteria were metastatic disease, severe walking impairments, renal failure stage > 2, ASA score > 3, preoperative chemo-radiation therapy. Patients have been randomized either to prehabilitation intervention groups, receiving 4-week trimodal prehabilitation (physical exercise and nutritional and psychological support) or to control receiving no prehabilitation. Both groups followed enhanced recovery programs and received rehabilitation accordingly. The primary outcome for functional capacity was measured by the 6-Minute Walking Test (6MWT) 4 and 8 weeks after surgery; to evaluate post-operative complications the Clavien-Dindo classification was used.ResultsAn interim analysis of 71 patients undergoing colorectal surgery was performed, with 35 assigned to interventional arm and 36 to control arm. Baseline characteristics were comparable in both groups. The prehabilitation group showed a significant increase in mean 6MWT distance pre-operatively compared to the control group, with an increase of 96 m (523 ± 24.6 vs. 427 ± 25.3, p = 0.01). At 4 and 8 weeks, the prehabilitation group maintained significant improvements, with an increase of 103 m (514 ± 89 vs. 411 ± 115, p = 0.003) and 90 m (531 ± 82 vs. 441 ± 107, p = 0.008), respectively. There were no statistical significant differences in post-operative complications and hospital length of stay between the two groups.ConclusionsThe preliminary results of this study indicate that it is feasible to implement a prehabilitation protocol lasting approximately 4 weeks. This protocol appears to yield a significant improvement in the physical performance of patients with colon cancer undergoing elective colorectal resection at 4 and 8 weeks after surgery.Graphical abstract

National Landscape of Neoadjuvant Therapy in Potentially Resectable Colon Cancer

IntroductionSurgery followed by pathology-guided adjuvant therapy is standard treatment for colon cancer. Data from the FOxTROT clinical trial showed potential benefit of a 6-wk neoadjuvant chemotherapy (NACT) in T3/T4 patients. The present study evaluated real-world outcomes of neoadjuvant therapy in a national cohort of patients with resectable colon cancer. Methods169,120 patients with clinical stage I, II, or III colon cancer from the National Cancer Database registry were included. Patients were categorized as having received neoadjuvant therapy followed by surgery (NACT), surgery then adjuvant chemotherapy (AC), or surgery alone. Factors associated with treatment sequencing and outcomes were assessed. ResultsOf identified patients, 1.4% received NACT including 0.5% of stage I, 1.8% of stage II, and 3.0% of stage III. For stage I, 5-y overall survival (OS) was 74.7% after AC, 62.2% after NACT, and 76.4% after SA. For stage II, 5-y OS was 73.2% after AC, 66.8% after NACT, and 64.3% after SA. For stage III, 5-y OS was 67.3% after AC, 67.7% after NACT, and 42.4% after SA. Cox proportional-hazards model suggested NACT had worse outcomes versus AC in clinical stages I (hazard ratio [HR] = 1.59, 95% confidence interval [CI] 1.39-1.85, P < 0.01) and II (HR = 1.37, 95% CI 1.23-1.52, P < 0.01). In stage III, there was no difference in OS between NACT and AC (HR = 1.1, 95% CI 0.99-1.22, P = 0.05). ConclusionsIn a real-world national cohort of patients with resectable colon cancer, NACT had no OS benefit over AC. Future studies should examine which subset of patients might benefit from neoadjuvant approaches.